Interventional Radiology - Current and Future
Interventional Radiology - Current and Future
A wide range of imaging modalities including planar imaging, computed tomography (CT), MRI, ultrasound and newer techniques such as PET are available. They are utilized in a variety of combinations, depending on the information required and the nature and complexity of the interventional procedure which is being planned. Imaging approaches vary between centers and often reflect local expertise. In most vascular patients, initial assessment is undertaken by duplex ultrasound, avoiding the need for ionizing radiation. Increasingly, patients also undergo pre-interventional assessment using magnetic resonance angiography, which is of particular value in planning interventions in the aorta and iliac vessels. Multi-detector row CT is the mainstay for the planning of endovascular abdominal and thoracic aneurysm repair and in follow-up after stent–graft deployment. Catheter angiography is now largely reserved for interventional procedures, but there are still occasions when this remains the most appropriate diagnostic modality. Additionally, angiography allows us to proceed immediately to intervention, which can be critical in emergency situations such as uncontrolled hemorrhage. When I started out as an interventional radiologist, most patients would have a diagnostic angiogram, but that's very rare these days as we can now get the information via noninvasive methods in all but a few cases, which has been an important step in reducing overall radiation burden. Obviously, the less x-rays used, the better it is for both the patient and angiography room staff, and so another important potential application of these newer imaging techniques is to develop interventional radiology (IR) procedures performed without fluoroscopy. Already there are a significant number of interventional procedures that can be performed under ultrasound control, and a great deal of work has already gone into developing the equipment and techniques required for guidance using MRI.
What Imaging Modalities Are Available to Radiologists & How Do They Differ?
A wide range of imaging modalities including planar imaging, computed tomography (CT), MRI, ultrasound and newer techniques such as PET are available. They are utilized in a variety of combinations, depending on the information required and the nature and complexity of the interventional procedure which is being planned. Imaging approaches vary between centers and often reflect local expertise. In most vascular patients, initial assessment is undertaken by duplex ultrasound, avoiding the need for ionizing radiation. Increasingly, patients also undergo pre-interventional assessment using magnetic resonance angiography, which is of particular value in planning interventions in the aorta and iliac vessels. Multi-detector row CT is the mainstay for the planning of endovascular abdominal and thoracic aneurysm repair and in follow-up after stent–graft deployment. Catheter angiography is now largely reserved for interventional procedures, but there are still occasions when this remains the most appropriate diagnostic modality. Additionally, angiography allows us to proceed immediately to intervention, which can be critical in emergency situations such as uncontrolled hemorrhage. When I started out as an interventional radiologist, most patients would have a diagnostic angiogram, but that's very rare these days as we can now get the information via noninvasive methods in all but a few cases, which has been an important step in reducing overall radiation burden. Obviously, the less x-rays used, the better it is for both the patient and angiography room staff, and so another important potential application of these newer imaging techniques is to develop interventional radiology (IR) procedures performed without fluoroscopy. Already there are a significant number of interventional procedures that can be performed under ultrasound control, and a great deal of work has already gone into developing the equipment and techniques required for guidance using MRI.
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